The lawyers at Aaron Waxman & Associates are experienced with Disability, Personal Injury and Employment claims.
Critical Illness Insurance is a relatively new product in the insurance world. Canadians are becoming more and more aware of its existence. It came to Canada in the mid to late 1990s. It is part of a Living Benefits Portfolio, intended to supplement disability insurance.
Critical Illness Insurance pays you a lump sum benefit. Payment of the benefit is based on a medical diagnosis versus a level of impairment which is the case in long term disability plans.
CI plans have a survival period you have to meet- usually 30 days, and it is exactly what it sounds like: you must survive 30 days after being diagnosed with a qualifying illness.
Coverage terminates upon payout of benefits.
What does CI insurance cover?
3 core “Illnesses”: Heart Attack, Stroke, Cancer
2nd Tier Conditions:
Other covered conditions: Bacterial Meningitis, Anemia
A Critical Illness policy is medically underwritten, meaning your medical history and family history are carefully reviewed. With disability insurance, your medical health is considered, but not as carefully examined and closely reviewed as with Critical Illness policies. In a long-term disability policy, your occupation is what is heavily weighed.
As with any insurance policy, there are likely issues that would require a lawyer’s help. We refer to those as “litigious issues”. Sometimes insurance companies attempt to rescind policies for material misrepresentation or non-disclosure. If you are purchasing a CI policy, you should not leave out important information such as pre-existing health conditions or appear to misrepresent yourself.
Section 308 of the Insurance Act states that it is up to the policy owner and the insured to disclose every fact withing their knowledge which is material to the insurer, and failure to do so, renders the contract voidable by the insurer.
The onus to prove that misrepresentation has happened is on the insurance company.
Another issue that might affect coverage is the actual diagnosis itself. First of all, a diagnosis must be made by a qualified specialist, and of course, the insurance company’s doctors have to agree with that diagnosis. Where some diagnoses may not be as clear cut as others, policy holders may run into difficulties.
At our firm, Aaron Waxman & Associates, we have handled many critical illness claims and are experienced in this area of law. We help our clients get access to the benefits they deserve and need.
* This blog is for informational purposes only and is not meant to substitute legal advice. Please read our disclaimer for further information.
* All of our lawyers are licensed by The Law Society of Upper Canada
* Office in Toronto and able to represent people in the province of Ontario
Disability & Personal Injury Blog